Although there are many different career paths for pharmacists, all may have a role in providing care to patients with a rheumatic disease. A pharmacist may benefit the patient and healthcare team from behind the scenes. Some examples include answering a question about a diabetes medication during a counseling session for adalimumab, checking a medication list for drug interactions or polypharmacy before dispensing a medication, answering a drug-information question regarding a rare side effect of a biologic, or providing assistance with the insurance approval process by summarizing peer-reviewed articles for off-label use of medication.
What Roles Could a Pharmacist Play?
Over the last decade, the practice of pharmacy has expanded to include extensive clinical training. This has extended the role of the pharmacist beyond preparing and dispensing medication, and enabled pharmacists to deliver of a wide range of patient-oriented services. As part of their education, pharmacists have considerable training in scientific literature evaluation and drug information. Their skill set makes them an asset to the busy practicing clinician.
Improved patient adherence: Patient adherence to treatments for chronic diseases is often poor. For example, only 45% of patients with osteoporosis continue to take their medications after the first year.2 Medication adherence in patients with rheumatoid arthritis (RA) has also been reported as low.3
A systematic review was performed to ascertain adherence in patients with RA or systemic lupus erythematosus (SLE). This review concluded that adherence to disease-modifying antirheumatic drugs and/or biologic medications in the treatment of RA or SLE was inadequate in many patients. Adherence varied by medication, delivery, and dosing schedule, but was also dependent on sociocultural characteristics, patients’ beliefs about medications, self-efficacy, and quality of communication with the physician.4 Another study, performed by Zwikker et al, developed a group-based intervention led by a pharmacist. This intervention was a time-efficient model that helped improve medication compliance in nonadherent RA patients.3 There are also many publications documenting very low rates of adherence to gout medications, which often leads to inflammatory attacks.5
The literature shows the current issues with medication adherence in patients with RA, SLE, and gout, and suggests the importance of patient education to improve adherence and strengthen the relationship of the patient with the rheumatology team. A pharmacist can play a major role in this effort. They can educate patients about how medications work, how to take medications, and the importance of adherence. A pharmacist can also provide education about side effects by clarifying what the patient reads on the Internet or hears on TV about a medication. Pharmacists are trained to interpret and analyze literature. By utilizing this skill through a one-on-one drug-education session, a pharmacist can ease patients’ fears and help them better understand the medication and improve adherence.
